title: A common error in the ecological regression of cancer incidence on the deprivation index.
abstract: OBJECTIVE
  To determine if introducing age as another explanatory variable in an ecological regression model relating crude rates of cancer incidence and a deprivation index provides better results than the usual practice of using the standard incidence ratio (SIR) as the response variable, introducing the non-standardized index, and not including age in the model.
  
  
  METHODS
  Relative risks associated with the deprivation index for some locations of cancer in Spain's Girona Health Region were estimated using two different models. Model 1 estimated relative risks with the indirect method, using the SIR as the response variable. Model 2 estimated relative risks using age as an explanatory variable and crude cancer rates as the response variable. Two scenarios and two sub-scenarios were simulated to test the properties of the estimators and the goodness of fit of the two models.
  
  
  RESULTS
  The results obtained from Model 2's estimates were slightly better (less biased) than those from Model 1. The results of the simulation showed that in all cases (two scenarios and two sub-scenarios) Model 2 had a better fit than Model 1. The probability density for the parameter of interest provided evidence that Model 1 leads to biased estimates.
  
  
  CONCLUSIONS
  When attempting to explain the relative risk of incidence of cancer using ecological models that control geographic variability, introducing age as another explanatory variable and crude rates as a response variable provides less biased results.
authors.affiliation: Universitat de Girona, Girona, Catalonia, Spain, gemma.renart@udg.edu.
authors.forename: Gemma
authors.initials: G
authors.lastname: Renart
authors.forename: Marc
authors.initials: M
authors.lastname: Saez
authors.forename: Carme
authors.initials: C
authors.lastname: Saurina
authors.forename: Rafael
authors.initials: R
authors.lastname: Marcos-Gragera
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ocaña-Riola
authors.forename: Carmen
authors.initials: C
authors.lastname: Martos
authors.forename: Maria A
authors.initials: MA
authors.lastname: Barceló
authors.forename: Federico
authors.initials: F
authors.lastname: Arribas
authors.forename: Tomás
authors.initials: T
authors.lastname: Alcalá
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000453:epidemiology*; D012015:Reference Standards; D012044:Regression Analysis; D012306:Risk; D013030:Spain / Q000453:epidemiology; D062206:Spatial Analysis; D055815:Young Adult